Delivery of Health Services Committee

Recommendations 12

• R1
  The health care function should be transferred from the Probation Department to the DHS.
• R2
  The health care program should be affiliated with a school of medicine.
• R3
  The level of health care services provided to detained juveniles in Los Angeles County should be in accordance with the American Academy of Pediatric standards for juveniles housed in juvenile court residential facilities. 10.00 On January 1, 1977, the DHS assumed responsibility for the health care of detained juveniles in the detention halls and camps, and formed a new division named JCHS. Under the direction of a new Medical Director, Dr. Charles Baker, the division immediately began making changes to bring the level of health care up to the American Academy of Pediatric standards and to seek affiliation with a school of medicine. Section 2008 35 By 1984, JCHS had improved its delivery of health services to the extent that it was one of the first programs in the nation to be accredited by the National Commission on Correctional Health Care. Also, in that year JCHS assumed responsibility for providing medical services to the DCS at MacLaren Children's Center. SCOPE OF TOPIC The scope of the work involved two major objectives: one, determine if present standards and service levels related to the delivery of health services in the Juvenile Court system match the standards that were established in 1976; and two, assess the desired level of health services which can be provided to the Probation and Children's Services Departments by JCHS. METHOD OF INVESTIGATION The following major tasks were performed in reviewing the services provided by the JCHS Division. Investigated key areas involved with the delivery of health services to youths in the Juvenile Court system. Conducted more than 36 interviews, including the following information sources: 0 Four interviews with DCS information sources One interview with Geraldine Dunn, Public Health Commission Chairman Ten interviews with Probation Department personnel
• R4
  care provided by Juvenile Court Health Services appears to meet the level established by the 1976 Task Force.
• R5
  The Grand Jury recommends the Probation Department perform a thorough cost and service evaluation at an appropriate time after implementation of the medical services contract. This evaluation should be performed for the San Fernando Valley Juvenile Hall and Camps Routh, Scott, Scudder and Holton to assess the impact of the Department's utilization of outside health care vendors.
• R6
  The Grand Jury recommends the Probation Department and Juvenile Court Health Services establish regular monthly meetings to improve communication. In addition, Juvenile Court Health Services should improve records maintenance and provide improved management information to Probation on a regular basis. This information, in conjunction with monthly meetings, will allow the Probation Department to obtain a thorough understanding of health services provided and thus improve control over health care services.
• R7
  The Grand Jury recommends the Department of Health Services perform an analysis of the Juvenile Court Health Services staffing structure. As part of the analysis, productivity measurements should be established and utilized to periodically evaluate staffing and required service levels. The Grand Jury recommends the Department of Health Services evaluate alternatives to present Juvenile Court Health Services health care practices to identify potential cost savings. In this connection, the Department of Health Services should evaluate utilizing trained non-medical staff to perform clerical duties and to dispense medications, thus reducing nurse staffing costs while maintaining current service levels and control over medications. In addition, the Department of Health Services should evaluate the feasibility of computerizing Juvenile Court Health Services' medical records to reduce excessive manual tracking and processing. . . . . . II. TRAUMA CENTERS AND COUNTY HOSPITAL FACILITIES PURPOSE The purpose of this review is to examine trauma care services in Los Angeles County and the related need for expansion of County hospital facilities to support trauma care services. FOCUS ISSUE The 1988-89 Los Angeles County Grand Jury directed Coopers & Lybrand to conduct a review of trauma care services in Los Angeles County. The review was requested by the Delivery of Health Services Committee to determine the adequacy of existing trauma care facilities in the County and the need for expansion of County hospital facilities to support trauma care services.
• R8
  The Grand Jury recommends that the Department of Health Services establish a reasonable, long-range financial commitment to compensate private hospitals and private physicians for indigent trauma care.
• R9
  The Grand Jury recommends that the Department of Health Services meet with hospitals participating in the County trauma system to determine levels of funding required to adequately compensate private hospitals for indigent trauma care. The Grand Jury recommends that the Department of Health Services meet with private hospitals and private hospital physicians to determine reasonable levels of private physician compensation in private hospitals for indigent trauma care.
• R11
  The Grand Jury recommends to the Board of Supervisors, that in order to encourage the return of private hospitals to the County trauma system, the County no longer charge private hospitals annually for their participation in the County trauma system. The annual payment amount should be determined as a result of discussions between the Department of Health Services and private hospitals. The Department of Health Services has been charging private hospitals between $15,000 and $35,400 annually to participate in the County trauma system.
• R12
  The Grand Jury recommends to the Board of Supervisors that the County pay private hospitals participating in the County trauma system, a fixed amount per completed trauma case to help offset losses associated with operating i.i trauma centers. The fixed amount should be determined as a result of discussions between the Department of Health Services and private hospitals. 49
• R13
  The Grand Jury recommends that the Board of Supervisors pursue through its legislative contacts revenue sources at the State level. The Grand Jury recommends that a permanent source of funding be established and mandated for the sole purpose of supporting trauma centers. Since the majority of trauma cases are automobile-related, the Grand Jury recommends that related revenue sources be pursued as follows: Vehicle taxes. Gasoline taxes. Automobile insurance recovery. The Grand Jury further recommends that the following additional revenue sources also be pursued: The creation of a special assessment district for the sole purpose of emergency medical services enhancement. Sales taxes. Taxes on beer and wine. Universal mandated health insurance. Community redevelopment funds (from cities). III. COMPLIANCE WITH HEALTH STANDARDS FOR RESTAURANTS PURPOSE The purpose of this review is to examine the ability of the Los Angeles County Department of Health Services (DHS) to meet its inspection requirements for restaurants. FOCUS/ISSUE The 1988-89 Los Angeles County Grand Jury directed Coopers & Lybrand to conduct a review of restaurant inspection requirements. The review was requested by the Delivery of Health Services Committee to determine if the recruitment, training, staffing and revenue resources are adequate to enable the County to meet its inspection requirements. 50